| NPI | 1467873778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 27495) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| 103TH0004X Psychologist Health | |
| 103TF0000X Psychologist Family | |
| 103TP2701X Psychologist Group Psychotherapy | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| Enumeration Date | 2014-01-05 |
| Last Update Date | 2015-09-22 |